Drug interactions
Clozapine + Levomilnacipran
Severity: Moderate
Clozapine and Levomilnacipran: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Levomilnacipran increases serotonergic and noradrenergic activity, and clozapine has its own serotonergic receptor effects. Together they may raise the risk of serotonin toxicity, and antipsychotic-related neuroleptic malignant syndrome is also a theoretical concern. Cases are uncommon but the outcome can be serious.
What this interaction means in plain words
Clozapine and Levomilnacipran can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Clozapine belongs to Central Nervous System; Levomilnacipran belongs to Central Nervous System.
Why it happens
Additive serotonergic activity (SNRI reuptake inhibition plus clozapine receptor effects) with possible additive dopamine blockade effects.
What to do
Monitor for mental status change, clonus, hyperreflexia, tremor, diaphoresis and hyperthermia, especially after initiation or dose increases. Stop the serotonergic agent and treat if serotonin syndrome or neuroleptic malignant syndrome is suspected.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Clozapine
- Clozapine + Deferiprone Contraindicated
- Clozapine + Irinotecan Contraindicated
- Clozapine + Pimozide Contraindicated
- Clozapine + Thioridazine Contraindicated
- Acalabrutinib + Clozapine Major
- Adagrasib + Clozapine Major
Other interactions of Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Clozapine with Levomilnacipran?
MediHelp rates the interaction as moderate. Clozapine and Levomilnacipran can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Levomilnacipran increases serotonergic and noradrenergic activity, and clozapine has its own serotonergic receptor effects. Together they may raise the risk of serotonin toxicity, and antipsychotic-related neuroleptic malignant syndrome is also a theoretical concern. Cases are uncommon but the outcome can be serious.
How serious is the interaction between Clozapine and Levomilnacipran?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for mental status change, clonus, hyperreflexia, tremor, diaphoresis and hyperthermia, especially after initiation or dose increases. Stop the serotonergic agent and treat if serotonin syndrome or neuroleptic malignant syndrome is suspected.
What other medicines interact with Clozapine?
MediHelp also lists interactions of Clozapine with, for example, Deferiprone, Irinotecan, Pimozide. The full list is on the Clozapine page.
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